Introduction

Lassa fever (LF) remains a major epidemic-prone disease in West Africa, placing recurrent pressure on health systems and exposing persistent gaps in outbreak preparedness and clinical capacity [1]. Nigeria bears a substantial share of the regional burden, and recurrent outbreaks highlight the need to move beyond emergency responses towards sustained investment in preparedness and health workforce development [2,3]. By epidemiological week 40 of 2026, Nigeria had recorded 1,138 confirmed cases and 268 deaths across 24 states, underscoring the continuing demands on clinical and public health services [4].

Effective outbreak response requires more than surveillance and laboratory capacity. Clinicians must promptly recognise disease, deliver appropriate care, implement infection prevention and control (IPC) measures, and coordinate multidisciplinary management under challenging conditions. These competencies extend beyond LF to other high-consequence infectious diseases. World Health Organization guidance for Ebola disease and mpox similarly emphasises clinical management, occupational safety, and IPC as essential components of outbreak response [5,6].

This Commentary examines Nigeria’s Lassa Fever Clinical Management Fellowship (LFCMF) as an approach to strengthening specialist clinical capacity and institutional preparedness. It considers the programme’s development and early outputs, its alignment with continental health security and sovereignty priorities, and its potential contribution to regional preparedness. It also identifies sustainability and evaluation priorities, recognising that the programme’s longer-term effects on clinical practice and patient outcomes require systematic assessment.

Nigeria’s Lassa Fever Clinical Management Fellowship: Programme development and implementations
Nigeria developed LFCMF to strengthen the clinical workforce responsible for managing LF and other high-consequence infectious diseases. Informed by stakeholder engagement, the programme provides a structured approach to specialist training beyond the demands of individual outbreaks. Its curriculum follows Nigeria’s national LF case-management guidelines and covers clinical assessment and management, IPC, and care coordination. A published account of the pilot phase describes 18 training modules and the initial training of 12 participants [7].

Across its first three cohorts, the programme graduated 62 participants: 12 in the first cohort, 19 in the second, and 31 in the third [7–10]. The third cohort expanded participation to include both doctors and nurses and introduced vaccine-related modules, broadening the curriculum to encompass emerging considerations in Lassa fever vaccine preparedness. Programme communications for the third cohort identified the Coalition for Epidemic Preparedness Innovations (CEPI) among the partners associated with its implementation [9]. The programme combined five weeks of virtual didactic sessions with a five-day clinical practicum. Implementation involved Nigerian clinical and public health institutions, with contributions from clinical facilitators and technical experts [9,10].

Although the number of graduates reflects the programme’s training reach, it does not, by itself, demonstrate improvements in clinical practice, institutional readiness, or patient outcomes. Further evaluation is needed to assess how fellows apply their training, strengthen clinical mentoring and multidisciplinary care, and contribute to sustained institutional preparedness. Transparent reporting of programme governance, funding arrangements, selection criteria, and follow-up outcomes would strengthen accountability and inform future expansion.

Strengthening national preparedness and health sovereignty
The COVID-19 pandemic exposed persistent inequities in global health governance and Africa’s dependence on external sources of medical products, technologies, and technical expertise. In response, the Africa Centres for Disease Control and Prevention (Africa CDC) advanced the New Public Health Order, emphasising stronger public health institutions, a skilled health workforce, local manufacturing, and African leadership in health security [11]. The subsequent Africa Health Security and Sovereignty Agenda reinforces the need for sustained domestic capacity to anticipate and respond to health threats [12]. Achieving these priorities requires investment not only in surveillance, laboratories, and medical products but also in the clinical workforce needed to translate preparedness into effective patient care.

The LFCMF supports this workforce agenda by building clinical expertise within Nigeria’s health system. By providing structured training in LF management and related outbreak-response competencies, the programme can help strengthen local capacity to manage high-consequence infectious diseases and reduce reliance on external clinical expertise during public health emergencies. Its longer-term contribution to health sovereignty will depend on sustained domestic investment, institutional support for trained fellows, and evidence that acquired competencies are translated into improved clinical practice and preparedness.

Regional health security and cross-border preparedness
LF poses a regional health security challenge because transmission and outbreak risks do not conform to national borders. Population mobility, cross-border movement, and differences in surveillance and response capacity can complicate timely case detection and management. Lessons from outbreaks involving Benin, Nigeria, and Togo highlight the importance of cross-border coordination, information sharing, and collaborative preparedness [13].

Nigeria’s experience in developing the LFCMF offers an opportunity to extend specialist clinical training beyond national needs. With appropriate institutional support and regional partnerships, the programme could facilitate knowledge exchange, clinical mentoring, and shared approaches to managing LF and other emerging infectious diseases across West Africa. Realising this potential would require deliberate collaboration with neighbouring countries and regional public health institutions, as well as evaluating the programme’s effectiveness and feasibility for participants from other settings.

Sustainability, evaluation, and future directions
The LFCMF’s long-term value will depend on sustained financing, institutional commitment, and integration into national preparedness strategies. Continued collaboration among clinical institutions, public health agencies, and development partners could support faculty development, clinical mentorship, and curriculum updates as evidence and management practices evolve. Potential development areas include simulation-based outbreak training, operational research, and structured exchanges with regional partners.

A systematic evaluation framework is also needed to assess whether the fellowship translates training into improved clinical practice and institutional readiness. Relevant indicators could include fellows’ deployment and retention, application of competencies, adherence to case-management and infection prevention protocols, clinical mentoring activities, and institutional preparedness for outbreaks. Patient outcomes and healthcare-associated infections may also be examined where reliable baseline data and appropriate evaluation designs are available. These measures would help identify implementation gaps, guide programme improvement, and provide a stronger evidence base for decisions on sustained investment and possible regional expansion.